Prostate cancer chronology

Background: 20% of all men age 55 have prostate cancer. By the time a man reaches the age of 70 that increases to approximately 50% and close to 100% by the age of 90. This is known because when men die from other causes, it is discovered at the autopsy that they had prostate cancer. Prostate cancer is extremely serious for a young man and generally is not imminently life threatening for a man over 65 unless it is a biologically aggressive tumor.

Diagnosis: Prostate cancer is generally discovered by a routine PSA (Prostate Specific Antigen) blood test or digital rectal exam by a physician. Promptly a biopsy is done to ascertain if it is actually malignant and determine the grade of the cancer by a pathologist. This is generally stated as the Gleason’s score from 2 to 10, 2 or 3 indicating that it is a very indolent, slow growing disease while 9 or 10 would indicate an extremely virulent, explosive type of a disease. The Gleason’s grade can change over a period of years.

Staging: Once the disease is determined to be malignant, it is necessary to know if it is localized or has spread, generally to the lymph system and/or the bones. This is done by CAT scans, bone scans, etc. There is no point in considering treatments until this has been completed. If the disease is localized, it is considered to be a curable disease. If the disease has spread (metastasized), it is not considered to be curable but it is treatable with many options and often can be controlled for many, many years.

Localized options: Depending on the patient’s age, state of mind, general health, and life expectancy, there are three general choices:

Do nothing but watch. In a man generally over 65 with a low Gleason’s grade who can mentally accept waiting, statistics show that life expectancy is not diminished by taking no immediate action. However, while it is localized is the only time it is considered curable. Do not relate this to any other type of cancer.

Surgery: A method of cure by removing the prostate gland. This is major surgery with the normal risks and side effects. Blood should be stored in advance to be transfused. If sexual function is a factor, a nerve sparing technique may be used resulting in up to 75% possibility of potency. Incontinence is normal for six months following surgery and may be permanent in about 5% of men.*

Radiation: External beam radiation offers the same statistics for cure as surgery out to 10 years. It is necessary to go to the same institution daily 5 days a week for about 7 weeks to receive a brief treatment. There is no feeling to the treatment but diarrhea and a burning urination are normal during treatment along with a feeling of being tired. The chances of continued sexual function are the same as the nerve sparing surgery and the chance of incontinence is remote.

*In an article dated 9/14/94 on a statistical analysis reported in JAMA, it stated, “The risks of surgically removing the prostate, including sexual impotency and urinary incontinence, do not justify the benefits on average, the analysis found.”

Metastasized Options: Depending on the patient’s age, state of mind, general health, and life expectancy, there are choices:

Do nothing but watch. In a man generally over 65 with a low Gleason’s grade who can mentally accept waiting, statistics show that life expectancy is not diminished by taking no immediate action. Do no relate this to any other type of cancer.

Orchiectomy: This is a simple outpatient surgery requiring only a few minutes to remove the testicles. Prostate cancer is dependent on the male hormone, testosterone. Removing the testicles removes the major source of this hormone and often most of the disease is destroyed. 70% to 80% of patients will appear in complete remission. The cancer will normally return over a period of years.

Chemical castration: This is about the same as the previous option but using a monthly shot instead of surgery. It is an expensive option that must be continued regularly. A pill may be added to enhance the effects. (Estrogen is another option but frowned upon because of other side effects.)

Advanced therapy: There are numerous treatments being used on advanced prostate cancer not receptive to any of the above and information them is available through PDQ by calling 1-800-4-CANCER.